EFFICIENCY OF TOMOTHERAPY IN THE TREATMENT OF LUNG CANCER IN MALES WITH CONCOMITANT CARDIOVASCULAR PATHOLOGY (EXPERIENCE OF THE “UMIT” INTERNATIONAL ONCOLOGY CENTER OF TOMOTHERAPY)

Abstract

Relevance: Non-small cell lung cancer (NSCLC) is frequently diagnosed in men with associated myocardial pathologies. Radiation therapy is one of the treatment methods for NSCLC; however, in Kazakhstan, there are virtually no studies on the efficacy and safety of tomotherapy in cancer patients with cardiac pathologies. 

The study aimed to evaluate the clinical results of mono-tomotherapy in patients with NSCLC and concomitant cardiac pathologies at the International Oncology Center for Tomotherapy “UMIT” (Astana, Kazakhstan). 

Methods: The study included 201 men with NSCLC who underwent spiral mono-tomotherapy at UMIT between 2020 and 2024. Patients were divided into Group 1 (n=139) – patients without cardiac pathologies- and Group 2 (n=62) – patients with severe associated cardiac pathologies. The average course duration was 32 days, the average treatment duration was 15 minutes, OD, 5 days a week. Treatment efficacy was assessed 8-12 weeks after completion of the course using PET-CT and CT data. 

Results: Complete regression was more common in patients in Group 1, while disease progression was more common in patients in Group 2. Partial responses were more common in Group 1, and stabilization of the oncological process was more common in Group 2. In Group 2, the proportion of patients with positive dynamics was 49%; after accounting for the identified stabilization of the process, it was 84%. In Group 1, the one-year overall survival rate was 84%, and 74% for stages III and IV, respectively, with a median progression-free survival of 10.3 months. The two-year survival rate for stage III disease was 65%. In Group 2, the one-year overall survival rate was 76% and 63% for stages III and IV, respectively, with a median progression-free survival of 8.1 months and a two-year survival rate of 54% for stage III. No device malfunctions were observed in Group 2. Two patients undergoing coronary artery bypass grafting experienced decompensated heart failure requiring temporary hospitalization. 

Conclusion: Tomotherapy demonstrates high clinical efficacy in the treatment of NSCLC with severe comorbid cardiac disease, although overall survival and treatment efficacy were lower than in patients without cardiac disease. Our experience confirms the feasibility of a relatively safe treatment in such patients when a personalized approach, strict dosimetric control, and multidisciplinary monitoring are employed.